Implementation of Early Discharges After Uncomplicated Vaginal Deliveries: Maternal and Infant Complications

Behram, Sheikh; Ef, Moschler; Sk, Sayegh; Fp, Garguillo; Wj, Mann

doi:10.1097/00007611-199806000-00006

Cited by 4 publications

(7 citation statements)

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“…All together, 1.7% of women were readmitted within 28 days. In other nonexperimental studies, the percentage varies from 0.5% (Behram, Moschler, Sayegh, Garguillo, & Mann, 1998) to 0.8% readmitted within 6 weeks (Meikle, Lyons, Hulac, & Orleans, 1998), to 0.3% readmitted within 2 weeks (Escobar et al, 2001), and to 1.75% to 2.7% readmitted within 3 weeks postpartum (Johnson et al, 2000). In a Cochrane review, Brown et al (2002) examined eight randomized trials and found a readmission rate of 0% to 4.9% within 6 weeks.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Health Care Utilization of Postnatal Programs in Sweden

Ellberg

Lundman

Persson

et al. 2005

Journal of Obstetric, Gynecologic & Neonatal Nursing

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Section: Discussionmentioning

confidence: 99%

Comparison of Health Care Utilization of Postnatal Programs in Sweden

Ellberg

Lundman

Persson

et al. 2005

Journal of Obstetric, Gynecologic & Neonatal Nursing

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“…Several economic analyses based on cohort studies or case series have concluded that the economic value of the resources released by early postnatal discharge are not offset by increased costs to other sectors of the health service or the wider economy 10–20 . However, in addition to basing assessments of the efficacy of early postnatal discharge policies on observational evidence, these economic analyses were characterised by a number of methodological limitations.…”

Section: Introductionmentioning

confidence: 99%

“…However, in addition to basing assessments of the efficacy of early postnatal discharge policies on observational evidence, these economic analyses were characterised by a number of methodological limitations. These included the adoption of a narrow economic perspective, 10–13,15–20 a failure to provide disaggregated information on reported costs 10,12–16,18–20 and limited sensitivity analyses 10–12,14–20 …”

Section: Introductionmentioning

confidence: 99%

Home‐based care after a shortened hospital stay versus hospital‐based care postpartum: an economic evaluation

Petrou

Boulvain

Simon

et al. 2004

BJOG

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Objectives To compare the cost effectiveness of early postnatal discharge and home midwifery support with a traditional postnatal hospital stay. Design Cost minimisation analysis within a pragmatic randomised controlled trial. Setting The University Hospital of Geneva and its catchment area. Population Four hundred and fifty‐nine deliveries of a single infant at term following an uncomplicated pregnancy. Methods Prospective economic evaluation alongside a randomised controlled trial in which women were allocated to either early postnatal discharge combined with home midwifery support (n= 228) or a traditional postnatal hospital stay (n= 231). Main outcome measures Costs (Swiss francs, 2000 prices) to the health service, social services, patients, carers and society accrued between delivery and 28 days postpartum. Results Clinical and psychosocial outcomes were similar in the two trial arms. Early postnatal discharge combined with home midwifery support resulted in a significant reduction in postnatal hospital care costs (bootstrap mean difference 1524 francs, 95% confidence interval [CI] 675 to 2403) and a significant increase in community care costs (bootstrap mean difference 295 francs, 95% CI 245 to 343). There were no significant differences in average hospital readmission, hospital outpatient care, direct non‐medical and indirect costs between the two trial groups. Overall, early postnatal discharge combined with home midwifery support resulted in a significant cost saving of 1221 francs per mother–infant dyad (bootstrap mean difference 1209 francs, 95% CI 202 to 2155). This finding remained relatively robust following variations in the values of key economic parameters performed as part of a comprehensive sensitivity analysis. Conclusions A policy of early postnatal discharge combined with home midwifery support exhibits weak economic dominance over traditional postnatal care, that is, it significantly reduces costs without compromising the health and wellbeing of the mother and infant.

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“…A shorter LOS also gives parents less time for the guidance and education they may need concerning the infant 5, 16. We must also recognize that there are patients who lack adequate home support or who may benefit from prolonged hospitalization 21.…”

Section: Discussionmentioning

confidence: 99%

“…A common suggestion is to decrease the costs through shortening the maternity LOS. However, without comprehensive support, patients would be ill served by an early discharge 21. Also, because the services are concentrated on the first day or two of the admission, decision makers should guard against overestimating the potential savings that may accrue from early discharge 11, 23.…”

Section: Discussionmentioning

confidence: 99%